How do Medicare Advantage plans work?

How do Medicare Advantage plans work?
How do Medicare Advantage plans work?
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How do Medicare Advantage plans work?

How do Medicare Advantage plans work? Medicare Advantage is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare that must follow rules set by Medicare. If you join a Medicare Advantage plan, you’ll still have Medicare, but you’ll get most of your Part A and Part B coverage from your Medicare Advantage plan, not Original Medicare. 

This “package” of plans includes   Medicare Part A (Hospital Insurance) Y  Medicare Part B (Medical Insurance)and, generally, Medicare drug coverage (Part D).

Find Medicare Advantage plans in your area.

Services covered by Medicare Advantage plans

With a Medicare Advantage plan, you can get coverage for things that Original Medicare doesn’t cover, like fitness programs (gym memberships or discounts) and some vision, hearing, and dental services (like routine checkups or cleanings). Plans can also choose to cover even more benefits. For example, some plans may offer coverage for services such as transportation to doctor visits, over-the-counter medications, and services that promote your health and wellness. Plans may also tailor their benefit packages to offer these benefits to certain members with some chronic conditions. These packages will provide personalized benefits to treat specific conditions. Check with the plan before you join to see what benefits it offers,  Learn more about what Medicare Advantage plans cover.

Medicare Advantage Plan Rules

Every month Medicare pays a set amount for your health care to companies that offer Medicare Advantage plans. These companies must follow rules set by Medicare.

Each Medicare Advantage plan may charge different out-of-pocket expenses. Also, they may have different rules about how you get services, such as:

  • If you need on derivation consult a specialist
  • if you need to see doctors, facilities, or providers that belong to the plan for non-emergency or urgent care.

These rules may change every year.

Medicare Advantage Plan Costs

What you pay in a Medicare Advantage plan depends on several factors. In many cases, you will need to use providers that participate in the plan’s network. Some plans do not cover services from providers outside of the plan’s network and service area.

Medicare Advantage plans have an annual limit on your out-of-pocket costs for all Part A and Part B services. When you reach the limit, you pay nothing for Part A and Part B covered services.

Learn about these factors and how to get cost details.

Casey Harward

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